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Lin MY, Najjar RP, Tang Z, Cioplean D, Dragomir M, Chia A, Patil A, Vasseneix C, Peragallo JH, Newman NJ, Biousse V, Milea D. The BONSAI (Brain and Optic Nerve Study with Artificial Intelligence) deep learning system can accurately identify pediatric papilledema on standard ocular fundus photographs. J AAPOS 2024; 28:103803. [PMID: 38216117 DOI: 10.1016/j.jaapos.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/26/2023] [Accepted: 10/15/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Pediatric papilledema often reflects an underlying severe neurologic disorder and may be difficult to appreciate, especially in young children. Ocular fundus photographs are easy to obtain even in young children and in nonophthalmology settings. The aim of our study was to ascertain whether an improved deep-learning system (DLS), previously validated in adults, can accurately identify papilledema and other optic disk abnormalities in children. METHODS The DLS was tested on mydriatic fundus photographs obtained in a multiethnic pediatric population (<17 years) from three centers (Atlanta-USA; Bucharest-Romania; Singapore). The DLS's multiclass classification accuracy (ie, normal optic disk, papilledema, disks with other abnormality) was calculated, and the DLS's performance to specifically detect papilledema and normal disks was evaluated in a one-vs-rest strategy using the AUC, sensitivity and specificity, with reference to expert neuro-ophthalmologists. RESULTS External testing was performed on 898 fundus photographs: 447 patients; mean age, 10.33 (231 patients ≤10 years of age; 216, 11-16 years); 558 normal disks, 254 papilledema, 86 other disk abnormalities. Overall multiclass accuracy of the DLS was 89.6% (range, 87.8%-91.6%). The DLS successfully distinguished "normal" from "abnormal" optic disks (AUC 0.99 [0.98-0.99]; sensitivity, 87.3% [84.9%-89.8%]; specificity, 98.5% [97.6%-99.6%]), and "papilledema" from "normal and other" (AUC 0.99 [0.98-1.0]; sensitivity, 98.0% [96.8%-99.4%]; specificity, 94.1% (92.4%-95.9%)]. CONCLUSIONS Our DLS reliably distinguished papilledema from normal optic disks and other disk abnormalities in children, suggesting it could be utilized as a diagnostic aid for the assessment of optic nerve head appearance in the pediatric age group.
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Affiliation(s)
- Mung Yan Lin
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Raymond P Najjar
- Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Center for Innovation & Precision Eye Health, Department of Ophthalmology and Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Zhiqun Tang
- Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | | | - Audrey Chia
- Duke-NUS Medical School, Singapore; Center for Innovation & Precision Eye Health, Department of Ophthalmology and Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Paediatric and Strabismus Service, Singapore National Eye Centre, Singapore; Myopia Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ajay Patil
- Department of Ophthalmology, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - Caroline Vasseneix
- Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Dan Milea
- Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Angers University Hospital, Angers, France; University of Copenhagen, Denmark; Rothschild Foundation Hospital, Paris, France; Neuro-Ophthalmology Department, Singapore National Eye Centre, Singapore.
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2
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deCampos-Stairiker MA, Coyner AS, Gupta A, Oh M, Shah PK, Subramanian P, Venkatapathy N, Singh P, Kalpathy-Cramer J, Chiang MF, Chan RVP, Campbell JP. Epidemiologic Evaluation of Retinopathy of Prematurity Severity in a Large Telemedicine Program in India Using Artificial Intelligence. Ophthalmology 2023; 130:837-843. [PMID: 37030453 PMCID: PMC10524227 DOI: 10.1016/j.ophtha.2023.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/08/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
PURPOSE Epidemiological changes in retinopathy of prematurity (ROP) depend on neonatal care, neonatal mortality, and the ability to carefully titrate and monitor oxygen. We evaluate whether an artificial intelligence (AI) algorithm for assessing ROP severity in babies can be used to evaluate changes in disease epidemiology in babies from South India over a 5-year period. DESIGN Retrospective cohort study. PARTICIPANTS Babies (3093) screened for ROP at neonatal care units (NCUs) across the Aravind Eye Care System (AECS) in South India. METHODS Images and clinical data were collected as part of routine tele-ROP screening at the AECS in India over 2 time periods: August 2015 to October 2017 and March 2019 to December 2020. All babies in the original cohort were matched 1:3 by birthweight (BW) and gestational age (GA) with babies in the later cohort. We compared the proportion of eyes with moderate (type 2) or treatment-requiring (TR) ROP, and an AI-derived ROP vascular severity score (from retinal fundus images) at the initial tele-retinal screening exam for all babies in a district, VSS), in the 2 time periods. MAIN OUTCOME MEASURES Differences in the proportions of type 2 or worse and TR-ROP cases, and VSS between time periods. RESULTS Among BW and GA matched babies, the proportion [95% confidence interval {CI}] of babies with type 2 or worse and TR-ROP decreased from 60.9% [53.8%-67.7%] to 17.1% [14.0%-20.5%] (P < 0.001) and 16.8% [11.9%-22.7%] to 5.1% [3.4%-7.3%] (P < 0.001), over the 2 time periods. Similarly, the median [interquartile range] VSS in the population decreased from 2.9 [1.2] to 2.4 [1.8] (P < 0.001). CONCLUSIONS In South India, over a 5-year period, the proportion of babies developing moderate to severe ROP has dropped significantly for babies at similar demographic risk, strongly suggesting improvements in primary prevention of ROP. These results suggest that AI-based assessment of ROP severity may be a useful epidemiologic tool to evaluate temporal changes in ROP epidemiology. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | - Aaron S Coyner
- Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Aditi Gupta
- Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Minn Oh
- Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Parag K Shah
- Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
| | - Prema Subramanian
- Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
| | | | - Praveer Singh
- Ophthalmology, University of Colorado, Aurora, Colorado; Radiology, MGH/Harvard Medical School, Charlestown, Massachusetts
| | - Jayashree Kalpathy-Cramer
- Ophthalmology, University of Colorado, Aurora, Colorado; Radiology, MGH/Harvard Medical School, Charlestown, Massachusetts
| | - Michael F Chiang
- National Eye Institute, National Institute of Health, Bethesda, Maryland; National Library of Medicine, National Institute of Health, Bethesda, Maryland
| | - R V Paul Chan
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - J Peter Campbell
- Ophthalmology, Oregon Health & Science University, Portland, Oregon.
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3
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Duong R, Abou-Samra A, Bogaard JD, Shildkrot Y. Asteroid Hyalosis: An Update on Prevalence, Risk Factors, Emerging Clinical Impact and Management Strategies. Clin Ophthalmol 2023; 17:1739-1754. [PMID: 37361691 PMCID: PMC10290459 DOI: 10.2147/opth.s389111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Asteroid hyalosis (AH) is a benign clinical entity characterized by the presence of multiple refractile spherical calcium and phospholipids within the vitreous body. First described by Benson in 1894, this entity has been well documented in the clinical literature and is named due to the resemblance of asteroid bodies on clinical examination to a starry night sky. Today, a growing body of epidemiologic data estimates the global prevalence of asteroid hyalosis to be around 1%, and there is a strong established association between AH and older age. While pathophysiology remains unclear, a variety of systemic and ocular risk factors for AH have recently been suggested in the literature and may provide insight into possible mechanisms for asteroid body (AB) development. As vision is rarely affected, clinical management is focused on differentiation of asteroid hyalosis from mimicking conditions, evaluation of the underlying retina for other pathology and consideration of vitrectomy in rare cases with visual impairment. Taking into account the recent technologic advances in large-scale medical databases, improving imaging modalities, and the popularity of telemedicine, this review summarizes the growing body of literature of AH epidemiology and pathophysiology and provides updates on the clinical diagnosis and management of AH.
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Affiliation(s)
- Ryan Duong
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Abdullah Abou-Samra
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Joseph D Bogaard
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Yevgeniy Shildkrot
- RetinaCare of Virginia, Augusta Eye Associates PLC, Fishersville, VA, USA
- Virginia Commonwealth University, Richmond, VA, USA
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4
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Sobhy M, Cole E, Jabbehdari S, Valikodath NG, Al-Khaled T, Kalinoski L, Chervinko M, Cherwek DH, Chuluunkhuu C, Shah PK, K C S, Jonas KE, Scanzera A, Yap VL, Yeh S, Kalpathy-Cramer J, Chiang MF, Campbell JP, Chan RVP. Operationalization of Retinopathy of Prematurity Screening by the Application of the Essential Public Health Services Framework. Int Ophthalmol Clin 2023; 63:39-63. [PMID: 36598833 PMCID: PMC9839316 DOI: 10.1097/iio.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Retinopathy of prematurity (ROP) is one of the leading causes of preventable pediatric blindness worldwide. ROP screening programs have been previously implemented in multiple low- and middle-income countries. On a global scale, it is crucial that evidence-based, standardized screening criteria are utilized in the early detection and treatment of ROP. In this review article, we utilize the National Public Health Performance Standards (NPHPS) Ten Essential Public Health Services Model organized by the core functions of assessment, policy development, and assurance to evaluate the barriers and successes of existing ROP screening programs. This framework can be applied to countries facing the third epidemic of ROP and can be used to establish a generalized model for eye care and screening worldwide.
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Elubous K, Alryalat SA, Qawasmeh S, Al-Ebous A, Abu-Ameereh M. Teleophthalmology research: Where do we stand? Eur J Ophthalmol 2023; 33:74-82. [PMID: 35570821 DOI: 10.1177/11206721221101360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To identify global research trends in teleophthalmology, as well as productivity and its association with Human development index (HDI). METHODS A cross-sectional study. The main outcome measures were publication count, citation count, and publications count per million populations. Bibliographic data were derived from the Web of Science website. HDI data were derived from Human Development Report [2020]. One-way ANOVA test was used to examine the association between HDI and the outcome measures. We studied the correlation between continuous variables using Spearman's. Bibliometric analysis software's VOSviewer and Citspace were used to analyse results and creating visualizing maps. RESULTS The results retrieved 355 publications, one-third of them have been published in the year of the COVID-19 pandemic; (2020). The USA has contributed to one-half of all publications, and just five countries have contributed to about 90% of all records. Very high HDI countries had significantly more publications count per million populations, than high (p-value = 0.0047), medium (p-value = 0.0081) or low HDI countries (p-value = 0.002). The main themes are screening programmes, reliability, photography, COVID-19, access, artificial intelligence, and cost-effectiveness. The leading countries in terms of both publications and citation count are the USA and India. In terms of publications count per million populations, the leading countries are Singapore and Australia. CONCLUSION Most of the contribution in teleophthalmology research was confined to a small number of countries. More effort is needed to expand the global contribution. The hotspots in this field are artificial intelligence applications and COVID-19 impact.
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Affiliation(s)
- Khaled Elubous
- Department of Ophthalmology, 54658University of Jordan, Amman, Jordan
| | | | - Sarah Qawasmeh
- Department of Ophthalmology, 54658University of Jordan, Amman, Jordan
| | - Ali Al-Ebous
- Department of Surgery, 37559King Hussein Cancer Center, Amman, Jordan
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6
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Bromeo AJ, Grulla-Quilendrino P, Lerit SJ, Gomez MC, Arcinue CA, De Jesus RA, Veloso A. Changes in Retina Practice Patterns During the COVID-19 Pandemic in the Philippines. Clin Ophthalmol 2021; 15:3493-3504. [PMID: 34429581 PMCID: PMC8378896 DOI: 10.2147/opth.s326594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/09/2021] [Indexed: 01/25/2023] Open
Abstract
Purpose The aim of this study was to assess the changes in clinical practice patterns among retina specialists in the Philippines in response to the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods This was a multi-center cross-sectional study based on a self-reported online survey. An online questionnaire was distributed among practicing retina specialists in the Philippines as listed in the database of the Vitreo-Retina Society of the Philippines using a combination of convenience and snowball sampling. The questionnaire contained questions regarding changes in clinic set-up, laser procedures, intravitreal injections, vitreoretinal surgery, and long-term outlooks. Results A total of 48 responses were recorded and analyzed with a view rate of 41.7%. There was a decrease in the number of clinic consults, laser procedures, intravitreal injections, and vitreoretinal procedures with most reporting only 1–25% of their usual patient load. Several modifications in clinic protocols have been made, including use of personal protective equipment, adjustments in clinic hours, and scheduling of only urgent cases. The adjustments implemented during the pandemic are expected by most respondents to be long-term changes. Conclusion Retina specialists in the Philippines have implemented changes in their practices to combat COVID-19, following guidelines issued by the local and international governing bodies on health.
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Affiliation(s)
| | | | | | | | - Cheryl A Arcinue
- Asian Eye Institute, Makati, Philippines.,Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines - Manila, Manila, Philippines
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7
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Nikolaidou A, Tsaousis KT. Teleophthalmology and Artificial Intelligence As Game Changers in Ophthalmic Care After the COVID-19 Pandemic. Cureus 2021; 13:e16392. [PMID: 34408945 PMCID: PMC8363234 DOI: 10.7759/cureus.16392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
Abstract
The current COVID-19 pandemic has boosted a sudden demand for telemedicine due to quarantine and travel restrictions. The exponential increase in the use of telemedicine is expected to affect ophthalmology drastically. The aim of this review is to discuss the utility, effectiveness and challenges of teleophthalmological new tools for eyecare delivery as well as its implementation and possible facilitation with artificial intelligence. We used the terms: “teleophthalmology,” “telemedicine and COVID-19,” “retinal diseases and telemedicine,” “virtual ophthalmology,” “cost effectiveness of teleophthalmology,” “pediatric teleophthalmology,” “Artificial intelligence and ophthalmology,” “Glaucoma and teleophthalmology” and “teleophthalmology limitations” in the database of PubMed and selected the articles being published in the course of 2015-2020. After the initial search, 321 articles returned as relevant. A meticulous screening followed and eventually 103 published manuscripts were included and used as our references. Emerging in the market, teleophthalmology is showing great potential for the future of ophthalmological care, benefiting both patients and ophthalmologists in times of pandemics. The spectrum of eye diseases that could benefit from teleophthalmology is wide, including mostly retinal diseases such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration but also glaucoma and anterior segment conditions. Simultaneously, artificial intelligence provides ways of implementing teleophthalmology easier and with better outcomes, contributing as significant changing factors for ophthalmology practice after the COVID-19 pandemic.
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Affiliation(s)
- Anna Nikolaidou
- Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, GRC
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8
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Ahuja AS, Bommakanti S, Farford B, Byrnes ÉS, Ten Hulzen RD, Dorairaj S. Teleophthalmology's Value in Screening for Blinding Eye Diseases. J Curr Ophthalmol 2021; 33:101-103. [PMID: 34409217 PMCID: PMC8365573 DOI: 10.4103/joco.joco_140_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/12/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Abhimanyu S Ahuja
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Sarvika Bommakanti
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Bryan Farford
- Department of Ophthalmology, College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Éamonn S Byrnes
- Florida State University College of Medicine, Tallahassee, Florida, USA
| | - Richard D Ten Hulzen
- Department of Ophthalmology, College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Syril Dorairaj
- Department of Ophthalmology, College of Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
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9
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A Reversible Watermarking System for Medical Color Images: Balancing Capacity, Imperceptibility, and Robustness. ELECTRONICS 2021. [DOI: 10.3390/electronics10091024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The authenticity and integrity of medical images in telemedicine has to be protected. Robust reversible watermarking (RRW) algorithms provide copyright protection and the original images can be recovered at the receiver’s end. However, the existing algorithms have limitations in their ability to balance the tradeoff among robustness, imperceptibility, and embedded capacity. Some of them are even not completely reversible. Besides, most medical image watermarking algorithms are not designed for color images. To improve their performance in protecting medical color image information, we propose a novel RRW scheme based on the discrete wavelet transform (DWT). First, the DWT provides a robust solution. Second, the modification of the wavelet domain coefficient guarantees the changes of integer values in the spatial domain and ensures the reversibility of the watermarking scheme. Third, the embedding scheme makes full use of the characteristics of the original image and watermarking. This reduces the modification of the original image and ensures better imperceptibility. Lastly, the selection of the Zernike moments order for geometric correction is optimized to predict attack parameters more accurately by using less information. This enhances the robustness of the proposed scheme against geometric attacks such as rotation and scaling. The proposed scheme is robust against common and geometric attacks and has a high embedding capacity without obvious distortion of the image. The paper contributes towards improving the security of medical images in remote healthcare.
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10
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Nadel A, Carter S, Hakimi AA, Dallalzadeh L, Hakim M, Garg S. Prospective evaluation of an iOS-based Mobile application to detect corneal injury. Am J Emerg Med 2021; 50:801-803. [PMID: 33745770 DOI: 10.1016/j.ajem.2021.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Arnold Nadel
- Chicago Medical School at Rosalind Franklin, University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Steven Carter
- Gavin Herbert Eye Institute at University of California, Irvine School of Medicine, 850 Health Sciences Road, Irvine, CA 92697, USA
| | - Amir A Hakimi
- Chicago Medical School at Rosalind Franklin, University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Liane Dallalzadeh
- Shiley Eye Institute at University of California, San Diego Health, 9415 Campus Point Drive, La Jolla, CA 92093, USA
| | - Melinda Hakim
- Melinda Hakim MD, 8816 Burton Way, Beverly Hills, CA 90211, USA
| | - Sumit Garg
- Gavin Herbert Eye Institute at University of California, Irvine School of Medicine, 850 Health Sciences Road, Irvine, CA 92697, USA
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11
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Teleophthalmology and the digital divide: inequities highlighted by the COVID-19 pandemic. Eye (Lond) 2020; 35:1529-1531. [PMID: 33257801 PMCID: PMC7703735 DOI: 10.1038/s41433-020-01323-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic has brought an unprecedented change in the way we deliver eye care to our patients, most notably with the rapid addition of telehealth technology into our practices. We have welcomed telehealth with open arms in hopes that it would improve access to care for our patients; however, one question remains: Does it improve health equity?
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12
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Chandra A, Romano MR, Ting DS, Chao DL. Implementing the new normal in ophthalmology care beyond COVID-19. Eur J Ophthalmol 2020; 31:321-327. [PMID: 33225734 DOI: 10.1177/1120672120975331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic has altered the clinical landscape immeasurably. The need to physical distance requires rethinking how we deliver ophthalmic care. Within healthcare, we will need to focus our resources on the five T's: Utilising technology, multidisciplinary clinical teams with wide professional talents need to work efficiently to reduce patient contact time. With regular testing, this will allow us to reduce the risk further. We also must acknowledge the explosion of different modalities to train our future ophthalmologists and the global challenges and advantages that these bring. Finally, we must not forget the psychological impact that this pandemic will have on ophthalmologists and ancillary staff, and need to have robust mechanisms for support.
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Affiliation(s)
- Aman Chandra
- Southend University Hospital NHS Foundation Trust, Essex, UK
- Anglia Ruskin University, Essex, UK
| | - Mario R Romano
- Department of Biomedical Science, Humanitas University, Milan, Italy
| | - Daniel Sw Ting
- Singapore National Eye Center, Duke-NUS Medical School, Singapore
| | - Daniel L Chao
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
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13
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Moguilner S, Pandya S, Schroeder S, Banach M, Ray D. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health 2020; 8:410. [PMID: 33014958 PMCID: PMC7505101 DOI: 10.3389/fpubh.2020.00410] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia.,Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Alberta Health Services and Project PoSSUM, University of Alberta, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.,Department of Hypertension, Medical University of Lodz, Łódz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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14
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Sommer AC, Blumenthal EZ. Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak. Graefes Arch Clin Exp Ophthalmol 2020; 258:2341-2352. [PMID: 32813110 PMCID: PMC7436071 DOI: 10.1007/s00417-020-04879-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose Technological advances in recent years have resulted in the development and implementation of various modalities and techniques enabling medical professionals to remotely diagnose and treat numerous medical conditions in diverse medical fields, including ophthalmology. Patients who require prolonged isolation until recovery, such as those who suffer from COVID-19, present multiple therapeutic dilemmas to their caregivers. Therefore, utilizing remote care in the daily workflow would be a valuable tool for the diagnosis and treatment of acute and chronic ocular conditions in this challenging clinical setting. Our aim is to review the latest technological and methodical advances in teleophthalmology and highlight their implementation in screening and managing various ocular conditions. We present them as well as potential diagnostic and treatment applications in view of the recent SARS-CoV-2 virus outbreak. Methods A computerized search from January 2017 up to March 2020 of the online electronic database PubMed was performed, using the following search strings: “telemedicine,” “telehealth,” and “ophthalmology.” More generalized complementary contemporary research data regarding the COVID-19 pandemic was also obtained from the PubMed database. Results A total of 312 records, including COVID-19-focused studies, were initially identified. After exclusion of non-relevant, non-English, and duplicate studies, a total of 138 records were found eligible. Ninety records were included in the final qualitative analysis. Conclusion Teleophthalmology is an effective screening and management tool for a range of adult and pediatric acute and chronic ocular conditions. It is mostly utilized in screening of retinal conditions such as retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration; in diagnosing anterior segment condition; and in managing glaucoma. With improvements in image processing, and better integration of the patient’s medical record, teleophthalmology should become a more accepted modality, all the more so in circumstances where social distancing is inflicted upon us. ![]()
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Affiliation(s)
- Adir C Sommer
- Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, 31096, Haifa, Israel
| | - Eytan Z Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, 31096, Haifa, Israel. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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15
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Abstract
BACKGROUND Low vision affects over 300 million people worldwide and can compromise both activities of daily living and quality of life. Rehabilitative training and vision assistive equipment (VAE) may help, but some visually impaired people have limited resources to attend in-person visits at rehabilitation clinics to receive training to learn to use VAE. These people may be able to overcome barriers to care through remote, Internet-based consultation (i.e. telerehabilitation). OBJECTIVES To compare the effects of telerehabilitation with face-to-face (e.g. in-office or inpatient) vision rehabilitation services for improving vision-related quality of life and near reading ability in people with visual function loss due to any ocular condition. Secondary objectives were to evaluate compliance with scheduled rehabilitation sessions, abandonment rates for VAE devices, and patient satisfaction ratings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any language restriction or study design filter in the electronic searches; however, we restricted the searches from 1980 onwards because the Internet was not introduced to the public until 1982. We last searched the electronic databases on 24 June 2019. SELECTION CRITERIA We planned to include randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in which participants diagnosed with low vision were undergoing low vision rehabilitation using an Internet, web-based technology compared with an approach involving in-person consultations. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and then full-text articles against the eligibility criteria. We planned to have two review authors independently abstract data from the included studies. Any discrepancies were resolved by discussion. MAIN RESULTS We identified two ongoing studies, but did not find any completed RCTs and CCTs that met the inclusion criteria for this review. We did not conduct a quantitative analysis. We discussed review articles on telemedicine for facilitating communication with elderly individuals or for providing remote ophthalmological care. AUTHORS' CONCLUSIONS We did not find any evidence from RCTs or CCTs on the efficacy of using telerehabilitation for remote delivery of rehabilitation services to individuals with low vision. Given the disease burden and the growing interest in telemedicine, the two ongoing studies, when completed, may provide evidence in understanding the potential for telerehabilitation as a platform for providing services to people with low vision.
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Affiliation(s)
- Ava K Bittner
- UCLA Stein Eye InstituteOphthalmology200 Stein Plaza DrivewayLos AngelesCaliforniaUSA90095
| | - Patrick D Yoshinaga
- Marshall B Ketchum UniversitySouthern California College of Optometry2575 Yorba Linda BoulevardFullertonCaliforniaUSA92831
| | | | - Tianjing Li
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 North Wolfe Street, E6011BaltimoreMarylandUSA21205
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16
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Scruggs BA, Chan RVP, Kalpathy-Cramer J, Chiang MF, Campbell JP. Artificial Intelligence in Retinopathy of Prematurity Diagnosis. Transl Vis Sci Technol 2020; 9:5. [PMID: 32704411 PMCID: PMC7343673 DOI: 10.1167/tvst.9.2.5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. The diagnosis of ROP is subclassified by zone, stage, and plus disease, with each area demonstrating significant intra- and interexpert subjectivity and disagreement. In addition to improved efficiencies for ROP screening, artificial intelligence may lead to automated, quantifiable, and objective diagnosis in ROP. This review focuses on the development of artificial intelligence for automated diagnosis of plus disease in ROP and highlights the clinical and technical challenges of both the development and implementation of artificial intelligence in the real world.
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Affiliation(s)
- Brittni A Scruggs
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - R V Paul Chan
- Department of Ophthalmology, University of Illinois, Chicago, IL, USA
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael F Chiang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - J Peter Campbell
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
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17
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Scruggs BA, Chan RVP, Kalpathy-Cramer J, Chiang MF, Campbell JP. Artificial Intelligence in Retinopathy of Prematurity Diagnosis. Transl Vis Sci Technol 2020. [DOI: 10.1167/tvst.210.2.2010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Brittni A. Scruggs
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - R. V. Paul Chan
- Department of Ophthalmology, University of Illinois, Chicago, IL, USA
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael F. Chiang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - J. Peter Campbell
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
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18
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Boureau AS, Masse H, Chapelet G, de Decker L, Chevalet P, Pichierri S, Weber M, Berrut G. Tele-ophthalmology for screening for eye diseases in older patients with cognitive complaints. J Telemed Telecare 2020; 27:493-500. [PMID: 31896286 DOI: 10.1177/1357633x19893883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Population-based studies show a significant increase in the prevalence of visual impairment in older patients. However, older patients and patients with lower Mini-Mental State Examination (MMSE) scores have few ophthalmological assessments. The main objective of our study was to evaluate the feasibility of tele-ophthalmological screening for ophthalmological diseases in older patients referred for cognitive assessment. METHODS This monocentric prospective study included patients referred to a memory clinic for cognitive assessment. All patients underwent a geriatric assessment comprising a cognitive assessment associated with tele-ophthalmological screening undertaken by an orthoptist, including undilated retinal photography. The retinal photographs were subsequently sent to an ophthalmologist. We identified patients who were not eligible for ophthalmological assessment, for patients that had to come back due to poor-quality retinal photographs and finally for detected eye diseases. The association between the geriatric variable and newly detected eye diseases was analysed in univariable and multivariable analyses. RESULTS The mean age of the 298 patients included was 83.5 years ± 5.65; 29.5% were male. The mean MMSE score was 20.8 ± 5.2; 66.3% of patients had a diagnosis of dementia. Eighteen patients (6.0%) were not eligible for ophthalmological examination and 13 patients (4.6%) were asked to come back owing to poor-quality retinal photographs. Forty-one patients (13.7%) had a newly detected eye disease. In multivariable analysis, patients with a lower MMSE had significantly more newly identified eye diseases. DISCUSSION The tele-ophthalmological screening method identified unknown ophthalmological diseases requiring specialised management in this older population with cognitive complaints.
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Affiliation(s)
- Anne-Sophie Boureau
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France.,L'Institut du Thorax, Université de Nantes, France
| | - Helene Masse
- Department of Ophthalmology, CHU de Nantes, Université de Nantes, France
| | | | - Laure de Decker
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Pascal Chevalet
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Sophie Pichierri
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Michel Weber
- Department of Ophthalmology, CHU de Nantes, Université de Nantes, France
| | - Gilles Berrut
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
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19
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Kern C, Fu DJ, Kortuem K, Huemer J, Barker D, Davis A, Balaskas K, Keane PA, McKinnon T, Sim DA. Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care. Br J Ophthalmol 2019; 104:312-317. [PMID: 31320383 PMCID: PMC7041498 DOI: 10.1136/bjophthalmol-2019-314161] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/24/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hospital Eye Services (HES) in the UK face an increasing number of optometric referrals driven by progress in retinal imaging. The National Health Service (NHS) published a 10-year strategy (NHS Long-Term Plan) to transform services to meet this challenge. In this study, we implemented a cloud-based referral platform to improve communication between optometrists and ophthalmologists. METHODS Retrospective cohort study conducted at Moorfields Eye Hospital, Croydon (NHS Foundation Trust, London, UK). Patients classified into the HES referral pathway by contributing optometrists have been included into this study. Main outcome measures was the reduction of unnecessary referrals. RESULTS After reviewing the patient's data in a web-based interface 54 (52%) out of 103 attending patients initially classified into the referral pathway did not need a specialist referral. Fourteen (14%) patients needing urgent treatment were identified. Usability was measured in duration for data input and reviewing which was an average of 9.2 min (median: 5.4; IQR: 3.4-8.7) for optometrists and 3.0 min (median: 3.0; IQR: 1.7-3.9) min for ophthalmologists. A variety of diagnosis was covered by this tool with dry age-related macular degeneration (n=34) being most common. CONCLUSION After implementation more than half of the HES referrals have been avoided. This platform offers a digital-first solution that enables rapid-access eye care for patients in community optometrists, facilitates communication between healthcare providers and may serve as a foundation for implementation of artificial intelligence.
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Affiliation(s)
- Christoph Kern
- Moorfields Eye Hospital, London, United Kingdom.,Department of Ophthalmology, University Eye Hospital, LMU, Munich, Germany
| | - Dun Jack Fu
- Moorfields Eye Hospital, London, United Kingdom
| | - Karsten Kortuem
- Moorfields Eye Hospital, London, United Kingdom.,Department of Ophthalmology, University Eye Hospital, LMU, Munich, Germany
| | - Josef Huemer
- Moorfields Eye Hospital, London, United Kingdom.,Eye Departement, Tauernklinikum, Zell am See, Austria
| | | | | | | | - Pearse A Keane
- Moorfields Eye Hospital, London, United Kingdom.,NIHR Biomedical Research Centre Biomedical Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Institute of Ophthalmology, University College of London, London, United Kingdom
| | | | - Dawn A Sim
- Moorfields Eye Hospital, London, United Kingdom .,NIHR Biomedical Research Centre Biomedical Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Institute of Ophthalmology, University College of London, London, United Kingdom
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20
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Valikodath N, Cole E, Chiang MF, Campbell JP, Chan RVP. Imaging in Retinopathy of Prematurity. Asia Pac J Ophthalmol (Phila) 2019; 8:178-186. [PMID: 31037876 PMCID: PMC7891847 DOI: 10.22608/apo.201963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/16/2019] [Indexed: 01/29/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness worldwide. Barriers to ROP screening and difficulties with subsequent evaluation and management include poor access to care, lack of physicians trained in ROP, and issues with objective documentation. Digital retinal imaging can help address these barriers and improve our knowledge of the pathophysiology of the disease. Advancements in technology have led to new, non-mydriatic and mydriatic cameras with wider fields of view as well as devices that can simultaneously incorporate fluorescein angiography, optical coherence tomography (OCT), and OCT angiography. Image analysis in ROP is also being employed through smartphones and computer-based software. Telemedicine programs in the United States and worldwide have utilized imaging to extend ROP screening to infants in remote areas and have shown that digital retinal imaging can be reliable, accurate, and cost-effective. In addition, tele-education programs are also using digital retinal images to increase the number of healthcare providers trained in ROP. Although indirect ophthalmoscopy is still an important skill for screening, digital retinal imaging holds promise for more widespread screening and management of ROP.
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Affiliation(s)
- N Valikodath
- From the Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, United States; and Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
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21
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Kern C, Kortuem K, Hamilton R, Fasolo S, Cai Y, Balaskas K, Keane P, Sim D. Clinical Outcomes of a Hospital-Based Teleophthalmology Service: What Happens to Patients in a Virtual Clinic? Ophthalmol Retina 2019; 3:422-428. [PMID: 31044734 DOI: 10.1016/j.oret.2019.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Demographic changes as well as increasing referral rates from national screening services put pressure on available ophthalmologic resources in the United Kingdom. To improve resource allocation, virtual medical retina clinics were introduced in 2016 in Moorfields Eye Hospital, South Division. The scope of this work was to assess clinical outcomes of patients followed up in a virtual clinic setting. DESIGN Retrospective database study. PARTICIPANTS Patients booked for a consecutive appointment in our virtual medical retina clinic. METHODS Seven hundred twenty-eight patients booked for their second virtual clinic appointment in a tertiary eye care referral center between November 2016 and July 2018 were identified retrospectively from our electronic health records and patient administration systems. Information about disease grade and clinical and visual outcomes was assessed. MAIN OUTCOME MEASURES Clinical outcome of the virtual clinic visit, including virtual follow-up, urgent referral to face-to-face clinic, or discharge. RESULTS Seven hundred twelve of 728 patients received a clinical outcome. Four hundred ninety-seven patients (70%) were eligible for further virtual follow-up after the second virtual clinic visit, whereas 15% each (107 and 108 patients) were either discharged or referred to a face-to-face clinic. In total, 661 patients attended their appointments in person and were reviewed by trained staff. Seventeen patients were referred for urgent treatment and 8 patients were not suitable for virtual follow-up. In 542 (82%) of all patients, diabetic retinopathy was the most common diagnosis. CONCLUSIONS This study reports clinical outcomes of a virtual model of care for medical retina clinics that imply safety of patient care in this clinic setting. This clinic format optimizes the use of already available resources and increases the skills of our existing workforce while maintaining high-quality clinical standards.
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Affiliation(s)
- Christoph Kern
- Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, University Hospital LMU, Munich, Germany.
| | - Karsten Kortuem
- Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, University Hospital LMU, Munich, Germany
| | | | | | - Yijun Cai
- Moorfields Eye Hospital, London, United Kingdom
| | | | - Pearse Keane
- Moorfields Eye Hospital, London, United Kingdom; National Institute for Health and Research Biomedical Centre, Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom
| | - Dawn Sim
- Moorfields Eye Hospital, London, United Kingdom; National Institute for Health and Research Biomedical Centre, Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom
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